Fully
aware of the legal consequences and bearing in mind the scope of my
decision, I decided to take preventive measures in handling my
personal matters for the event that due to illness or a limitation of
my physical, mental of emotional capacities I shall be fully or
partially unable to take care of my own matters and/or shall be
unable to exercise my right to self determination with regard to my
own personal and health related matters.

The
purpose of this advance medical directive is to specify in a legally
binding manner which medical diagnoses and treatments I wish to
strictly exclude and which ones I wish to allow, thus to which
medical diagnoses and treatments an authorized legal agent or any
other representative legally appointed by myself can give his/her
permission and which ones he/she must refuse on my behalf. By
designating legal agents at the end of this advance medical
directive, whose authorization, however, only comes into effect on
the condition that the appointed individuals strictly adhere to the
directives given in this document, I wish to functionally replace a
potential court order by a guardianship court for the appointment of
a legal guardianship against my will in order to transfer the
representation of my interests and the decision making powers in
relation to myself in such an event to individuals I particularly
trust and strictly, bindingly and under all circumstances prevent my
retention in a locked psychiatric facility.

deny
the existence of any psychiatric illness, and instead consider the
use of psychiatric jargon and psychiatric diagnoses as slander and a
serious assault to my personality, and forced detention in a
psychiatry as a serious violation of my right to freedom, and as I
consider any type of psychiatric force treatment as torture and the
most serious degree of grievous bodily harm, I wish to, pursuant to §
1901 a German Civil Code, establish an advance directive in order to
protect myself from being given such diagnoses, i.e. slander and its
consequences, by refusing to be subjected to the following medical
procedures:

A)
Under no circumstances
may I be given any psychiatric diagnosis. I hereby prohibit all
psychiatric specialists from examining me, in the same way as I
prohibit all doctors who wish to examine me from attempting to give
me any of the diagnoses listed in chapter 5 of the International
Statistical Classification of Diseases (currently ICD 10th revision)
as codes F00 through to F99 under the heading "Mental and
Behavioral Disorders", and in order to prevent any possible
misinterpretations, I hereby specify these as follows:

F00-F09
Organic, including symptomatic, mental disordersF10-F19
Mental and behavioral disorders due to psychoactive substance useF20-F29 Schizophrenia,
schizotypal and delusional disordersF30-F39
Mood [affective] disordersF40-F48 Neurotic, stress-related and
somatoform disordersF50-F59
Syndromes associated with physiological disturbances and physical
factorsF60-F69 Disorders of adult personality and behaviorF70-F79 Mental
retardationF80-F89 Disorders of psychological developmentF90-F98 Behavioral and
emotional disorders with onset usually occurring in childhood and
adolescenceF99
Unspecified mental disordersincluding
all further sub-specifications and more recent modifications of this
chapter of the ICD.

B)I strictly refuse the following
treatments: - Treatments by a psychiatric specialist or an
assisted outpatient treatment team. - Treatment in a psychiatric
hospital ward or outpatient clinic or a so-called crisis intervention
team. - Any restriction of my freedom, e.g. retention in a
psychiatric ward, any restraint, any treatment against my expressed
will, any forced treatment regardless of which substances that are
referred to as "medication" or which placebos are
administered.

-
Treatments only volontary with written permission
…………………………………………………………………………………

C)It is my explicit wish that the
following treatments are given in the event that an illness has
reached an irreversibly terminal state:

…………………………………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………………………………….

D)On
the condition that the directives given in sections A) to C) are
followed, I hereby appoint the following legal agents, who, pursuant
to § 1896 section 2 German Civil Code, are entitled to represent
me as individual legal entities. The appointment comes into effect
provided that the directives specified in this document are followed.
The respective appointment is immediately revoked in the event that
the appointed legal agent's decision diverges from the directives
specified in sections A) to C).

All
appointments pertain to all of the specified responsibilities, in
particular to place of residence, healthcare and assets, unless the
latter has been crossed out. In the event that the instructions given
by the respective legal agents diverge from each other, the
instruction given by the legal agent associated with the lower
ordinal number shall be deemed valid.

Right
of RevocationI am
aware of my right to fully or partially revoke this advance medical
directive and power of attorney given herein at any time, provided
that I am contractually capable at that time. I am aware of the scope
and legal consequences of this power of attorney on which I have
gathered sufficient information.

This
power of attorney was established voluntarily, uninfluenced and while
in full possession of my mental capacities.

In
addition to this advance medical directive, I present a copy of a
medical certificate confirming my contractual capability, so that my
free will expressed in this advance medical directive and the
validity of this advance medical directive are indisputable. The
original of that medical certificate remains with me. This advance
medical directive is registret under no. 224 588 195 at the Zentrale
Vorsorgeregister (ZVR) (https://www.zvr-online.de/)
and published here:
http://wkeim.bplaced.net/files/patverfue-en_neu.html